From cradle to grave nursing: highly respected and much loved East Coast public health nurse Mandy Ruru looks back on four decades of work and change.

'She's been a wonderful rote model to her colleagues, an icon in the community and her leaving has left a huge gap in public health in Tairawhiti." These are just some of the responses from colleagues to the retirement of Gisborne public health nurse (PHN) Mandy Ruru, who ended 41 years' work in the Tairawhiti region at the end of June. She left with no regrets and a sense of satisfaction for a job well done.

Ruru's PHN career began in the 1960s, when she applied for a job in Gisborne, an area of the country she had never been before. This followed nurse training at Wellington Public Hospital in the 1950s and some home-based nursing in the United Kingdom which gave her a taste for working with families in their own homes. On returning to New Zealand, she completed the six-week PHN course in Wellington and the four-month Plunket training course in Dunedin, a compulsory component of PHN work at that time.

"Having infant welfare as part of our role meant we had an entree into people's homes," she said. "Our work stretched from the cradle to the grave and meant we got to know families across the generations. I also did outreach work from the children's, neotnatal and maternity wards at Gisborne Hospital, working closely with the paediatricians. This helped build my profile and to win people's trust. The variety of the role is what attracted me to it. In those early decades, there were few restrictions on how many visits we could make. An early entree into the home means you can pick up on family problems as soon as they emerge, then work intensively to alleviate them. With time, energy and the right people beside you, you can achieve so much."

Tairawhiti District Health Board's public health nursing service Lost its 0-5 contract at the end of May this year. This is now being managed by Plunket and two Maori providers. For Ruru, it was the signal for her to go. "My forte had been working with infant welfare. The generalist role that PHNs once had is gone, with contracts now divided among a number of different providers."

During the 1970s, Ruru became the key person, working alongside paediatrician David Frankish, in the successful development of the first rheumatic fever intramuscular prophylaxis programme. PHNs were chosen as the group most appropriately positioned to give the four-weekly benzathine penicillin injections, due to their involvement with families and schools and their child health profile. "Rheumatic fever was prevalent in Gisborne, the East Coast and northern New Zealand. Local success in its control by a dedicated PHN team prompted interest throughout the country and the Pacific. This simple, free, near full-proof programme resulted in a Large proportion of those diagnosed with the disease experiencing an initial attack only. Millions of health budget dollars were saved that would have been used up in cardiac valve surgery; young Lives were rescued and their quality of Life preserved. Preventing and treating rheumatic fever has been one of the great passions of my career."

During the 1980s Ruru became a BCG vaccinator, joining the Health Department team who vaccinated third form students in Wairoa, Opotiki, Gisborne and the East Coast annually. In 1990, she was appointed to the newly established position of child care co-ordinator for Tairawhiti, a rote she continued until retirement. This involved working exclusively and preventatively with at-risk families. "I received referrals from all and sundry. I was often first to diagnose potential child abuse situations and, when initial interventions failed to achieve child safety, I referred cases on to Children, Young Persons and their Families Service. My work revolved around home visiting, as this is where all aspects of a family's health and well-being develop, both the good and bad."

Another of Ruru's passions has been prevention and support in the area of Sudden Infant Death Syndrome (SIDS). In 1990, she became chair of the local support group. That year, the Public Health Unit was visited by Auckland GP Carol Everard and her team representing the national co-ordination of SIDS' prevention in Maori communities. They spent time with Ruru and Maori community health worker Anita Smith, studying the preventative programme they had set up. Key to the programme's success was early intervention and intensive work with families, assisting with a range of health indicators such as housing, clothing, nutrition and family violence. The programme eventually became the model for other New Zealand communities. Ruru and Smith (the Latter being younger and Maori while Ruru was older and Pakeha) began a round of marae-based, information sharing hui throughout the East Coast, Auckland and Northland regions.

Ruru was Later invited to become a member of the Child, Youth and Family Care and Protection Panel, due to her extensive knowledge of the Local community and her role in child abuse prevention. She has found the experience interviewing social workers and discussing their plans invaluable and she remains a member still, at the panel's request.

Ruru has received a number of honours during her Long career. In 1990 she received the Queen's Commemoration Medal for her services to the Tairawhiti community. This year she was made an honorary life member of the National Children's Health Camp Board at an "amazing" Local ceremony. "During my PHN career, I have referred hundreds of children with poor health or behavioural problems to the Local health camp in Gisborne and have seen countless positive outcomes for the tamariki and whanau concerned. This camp is still a wonderful resource, well respected and used frequently by all PHNs in this region, where and when appropriate."

Over the years, Ruru has observed many changes in public health nursing. Prime among them has been the establishment of many community-based Maori providers, with whom she has worked closely. She has also been delighted that more Maori are choosing to go nursing, some of whom she has personally encouraged and mentored. Ruru has enormous respect for the PHNs she has worked with over the last four decades. "They were strong, dedicated women, who were prepared to think outside the square and advocate for those Less privileged than themselves. PHNs are a special breed of people who have a unique opportunity to make a huge difference in health and they usually do."